As many as 20 million Americans are supposed to enroll in the online marketplaces and purchase health insurance this year. But many people still aren't aware that the exchanges even exist.

The next time you tune in to watch “Modern Family,” the plot may involve members of the Pritchett-Dunphy clan signing up to purchase insurance coverage on the California health exchange.

OK, maybe not. But that’s one of the many ideas that have been floated as a way to educate the public about the upcoming changes to the health insurance market. State-run online insurance marketplaces are crucial to the Affordable Care Act’s (ACA) goal of universal health coverage, but those exchanges can only function well if people know to sign up.

This October, as many as 20 million Americans are supposed to enroll in the exchanges and purchase health insurance -- often with the help of federal tax subsidies -- for 2014. But many people still aren’t aware that the exchanges even exist. Getting all those people to the virtual market will be a monumental challenge. If fewer people enroll, insurers will have fewer people to make up their coverage pools, and that drives up premium rates for everyone.

“Beyond the Beltway, nobody knows anything about the [ACA],” says Kim Holland, executive director of state affairs for the BlueCross/BlueShield Association. “We cannot underestimate the amount of effort it will take to get people to the system.”

So states are getting creative. California has signed a $900,000 contract with Ogilvy Public Relations Worldwide to market its exchange. Some of the ideas the group has explored are rather nontraditional: How about a reality show chronicling the struggles of people living without health insurance, with the occasional plug for the exchange? What about writing the exchange into plotlines for primetime shows like “Modern Family” or “Grey’s Anatomy”?

Washington state is reportedly considering airing health exchange ads on Pandora Internet radio stations. Oregon might print notices on coffee cup sleeves so residents could get a public service announcement along with their Starbucks fix. More traditional avenues like newspaper and radio advertisements are also on the table.

“The uninsured population is an extremely difficult population to reach,” Michael Marchand, director of communications for the Washington State Health Benefit Exchange, recently told Politico. “They’re uninsured for a reason. How much will it actually take to get people both understanding the value [of the exchange] as well as taking action to enroll?”

Determining just what to call an exchange can also be a big marketing decision. States hope the right name can help spur public awareness. The concept of a “health exchange” doesn’t mean anything to the average person. California, for instance, toyed with some esoteric names like “Avocado” and “Europa” before settling on something much more mundane: Covered California.

Even the federal Department of Health and Human Services, faced with the prospect of running exchanges in as many as 30 states in 2014, is working to make things easier to understand. In mid-January, the department announced that it would stop referring to “exchanges” (a decidedly wonky term) and instead call them “health insurance marketplaces.” “We felt simpler was better,” a spokesman told USA Today.